Creating space to discuss end-of-life issues in cancer care.
Dagoberto Cortez, Douglas W Maynard, Toby C Campbell
PMID 30007763WHAT IT FOUND
In lung cancer visits where scans showed progression, oncologists sometimes said treatment had stopped working and moved quickly to options.
Patients and caregivers often stayed silent. Scan meaning and end-of-life topics often went unopened.
Key findings
01In 22 visits with scan results showing tumor growth or metastasis, exhausted current treatment statements were present in 7, and oncologists moved into treatment talk.
02Patients and caregivers often stayed silent after bad scan news, which helped oncologists avoid unpacking what the scan meant.
03The authors say the pattern does not generalize to all oncology visits, but exhausted current treatment statements can forestall end-of-life discussion by pivoting to other treatment options.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The authors say this is a small conversation collection and not generalizable to all oncology visits. The analysis focused on lung cancer visits where scans showed tumor growth or metastasis, so it may not apply to other cancers or visit types. The authors describe missed opportunities as co-constructed, so the finding does not show that oncologists alone caused the lack of end-of-life discussion.
Declared interests
The authors declared no conflicting interests. The article is tagged as NIH extramural research support.
The easy way to misread this
Do not conclude that oncologists deliberately avoid end-of-life talk or that patients do not want it. The study shows a recurring conversation pattern in a small collection of lung cancer visits, and the authors say it does not generalize to all oncology visits.